Combined kidney/bone marrow transplantation

Within the past few years, a new conceptual view of transplantation has emerged, based on the observation that renal transplant recipients with extremely long (27-29 years) graft survival all have had evidence of donor cells in their peripheral blood, skin, and lymph nodes. They were thus chimeric. This led to the theory that chimerism is necessary for successful long-term engraftment. It also led to the next logical step of attempting to augment chimerism by transplanting donor bone marrow at the time of organ transplantation. Early reports of combined organ/bone marrow transplantation have suggested that it is safe and is associated with reasonable outcomes. In this paper, we discuss the outcome in the first 30 patients undergoing combined kidney/bone marrow transplantation.